US8357090B2 - Method and apparatus for estimating water reserves - Google Patents
Method and apparatus for estimating water reserves Download PDFInfo
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- US8357090B2 US8357090B2 US11/716,778 US71677807A US8357090B2 US 8357090 B2 US8357090 B2 US 8357090B2 US 71677807 A US71677807 A US 71677807A US 8357090 B2 US8357090 B2 US 8357090B2
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Images
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
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- A—HUMAN NECESSITIES
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- A61B5/44—Detecting, measuring or recording for evaluating the integumentary system, e.g. skin, hair or nails
- A61B5/441—Skin evaluation, e.g. for skin disorder diagnosis
- A61B5/443—Evaluating skin constituents, e.g. elastin, melanin, water
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- A—HUMAN NECESSITIES
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- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
- A61B5/0075—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence by spectroscopy, i.e. measuring spectra, e.g. Raman spectroscopy, infrared absorption spectroscopy
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- A—HUMAN NECESSITIES
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- A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
- A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
- A61B5/1075—Measuring physical dimensions, e.g. size of the entire body or parts thereof for measuring dimensions by non-invasive methods, e.g. for determining thickness of tissue layer
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- A—HUMAN NECESSITIES
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- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/44—Detecting, measuring or recording for evaluating the integumentary system, e.g. skin, hair or nails
- A61B5/441—Skin evaluation, e.g. for skin disorder diagnosis
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- A—HUMAN NECESSITIES
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- A61B5/48—Other medical applications
- A61B5/4869—Determining body composition
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- A—HUMAN NECESSITIES
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- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
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Definitions
- the present invention relates generally to determining physiological parameters and, more particularly, to estimating water reserves.
- a method for determining a water reserve index comprises determining a lean water fraction of tissue and skin thickness for at least one site. The method also comprises combining the lean water fraction and skin thickness to produce a water reserve estimate.
- a method for determining skin thickness comprises emitting electromagnetic radiation from a sensor at an individual's skin and detecting the emitted electromagnetic radiation after it has been scattered and absorbed by constituents of the skin.
- the method also comprises determining the prominence of spectral features corresponding to a subcutaneous fat layer, wherein the prominence of spectral features indicates skin thickness.
- a system for determining a water reserve index includes a sensor comprising an emitter configured to emit near-infrared light and a detector configured to detect the emitted light and generate a signal representative of the detected light.
- the system also including a monitor communicatively coupled to the sensor and configured to receive the generated signal.
- the monitor comprising a microprocessor configured to calculate a lean water fraction based on the received signal.
- the microprocessor further configured to combine the lean water fraction with a skin thickness value to determine a water reserve index.
- the monitor also comprising a display configured to display the determined water reserve index to the user.
- FIG. 1 illustrates a system for determining hydration in accordance with an exemplary embodiment of the present invention
- FIG. 2 illustrates a cross-sectional view of a sensor of the system of FIG. 1 in accordance with an exemplary embodiment of the present invention
- FIG. 3 illustrates a plot of euhydrated skin showing lipid (fat) peaks at 1210 nm, 1725 nm, and 1765 nm;
- FIG. 4 illustrates a plot of the euhydrated skin of FIG. 3 and plot showing reduction of the lipid peaks as an effect of overhydration
- FIG. 5 illustrates a technique for determining a hydration index based on an estimate of the fraction of water in the skin and skin thickness, in accordance with an exemplary embodiment of the present invention.
- a system and method for estimating an individual's water reserves.
- the technique includes determining a water reserve index based on two factors: an estimate of the lean water fraction and the thickness of the skin.
- the two factors may be used to produce a water reserve index indicative of the amount of water reserves an individual has available in the form of skin cell hydration.
- the water reserve index may be measured relative to a level of skin hydration clinically determined to be indicative of a dehydrated state. Accordingly, the water reserve index may be indicative of an amount of water above or below the dehydrated level.
- the system 10 includes a sensor 12 coupled with a monitor 14 via a cable 16 .
- the system may also include an input device, such as a keyboard 18 and an output device, such as a display 20 .
- the keyboard 18 may be configured to allow a user, such as a clinician, to enter various parameters or baseline hydration levels, as will be discussed below.
- the display 20 may be configured to display a lean water fraction, a skin thickness, and/or a water reserve index measurement among other things.
- the sensor 12 is configured to contact an individual's skin 22 on a site where measurements are to be taken.
- a cross sectional view of the sensor 12 is shown in FIG. 2 to illustrate that the sensor 12 may include at least one emitter 24 and at least one detector 26 component parts of the sensor 12 .
- the emitter 24 and the detector 26 are located on a substantially flat surface of the sensor 12 so that they may optically couple with an individual's skin 22 .
- the emitter 24 may include one or more electromagnetic radiation sources or light sources, such as light emitting diodes (LEDs), an array of LEDs, a white light source, a tunable laser, or any other source that transmits electromagnetic radiation within a region of the electromagnetic spectrum useful for the determination of physiological parameters.
- electromagnetic radiation sources or light sources such as light emitting diodes (LEDs), an array of LEDs, a white light source, a tunable laser, or any other source that transmits electromagnetic radiation within a region of the electromagnetic spectrum useful for the determination of physiological parameters.
- the near-infrared region (NIR) of the electromagnetic spectrum is particularly useful in measuring relative concentrations of tissue constituents for the determination of skin thickness and water content.
- NIR near-infrared region
- the detector 26 may be a photosensitive diode, photosensitive transistor or other means for detecting electromagnetic radiation within the range of the electromagnetic spectrum of the emitter 24 .
- the detector 26 is configured to detect electromagnetic radiation originating from the emitter 24 after it has passed through a patient's skin and been absorbed and/or scattered by the constituent parts of the tissue.
- the sensor 12 may be a reflection-type sensor, as illustrated in FIG. 1 , where the emitter 24 and detector 26 are substantially in the same plane and spaced 1-5 mm apart, or a transmission-type sensor, where the emitter 24 and detector 26 are placed on substantially opposite sides of the tissue site. More specifically, because the detector 26 is in the same plane as the emitter 24 in the reflectance-type sensor, the detector 26 detects light that has been reflected and/or scattered by the tissue. In contrast, in a transmission-type sensor, the sensor's emitter and detector lie in parallel planes on opposing sides of the tissue.
- the optical path of the light originating from an emitter in a transmission-type sensor is substantially in-line with an imaginary axis connecting the emitter and the detector, and the detector detects light that has been transmitted through the tissue along the optical path.
- NIR near-infrared
- the spectral absorption bandwidth may be used to estimate tissue constituent concentration and, more specifically, water content of tissue, as disclosed in U.S. patent application Ser. No. 11/528,154 which is also incorporated by reference.
- the lean water fraction may generally be described as a ratio of the water-to-protein in the tissue. Protein content may be challenging to estimate because it comprises a class of thousands of different molecules and many of the absorption peaks in the protein spectrum are close to absorption peaks for fat. Water, however, is generally the most prominent absorber in the NIR spectrum. The absorption spectrum of water varies primarily with the degree of hydrogen bonding between water and/or other polar molecules, but most of this variation may be correlated with temperature, which can be easily measured. The lean water fraction may be correlated to a whole body hydration index or a local hydration index.
- skin thickness may be used to estimate an individual's water reserves and provide an index of the individual's water reserves.
- the skin may be a major reservoir of water for the body.
- thicker skin indicates the body has the capacity for storing more water and thinner skin indicates the body has the capacity for storing less water.
- the skin thickness may be used in conjunction with other methods for determining hydration levels to estimate an individual's water reserves.
- Skin thickness may be measured by any of a number of suitable techniques.
- skin thickness may be measured by spectroscopic means.
- a subcutaneous fat layer can be seen in spectroscopic analysis of the human skin and mammalian skin, in general.
- FIG. 3 experiments on euhydrated porcine models show that the subcutaneous fat layer is readily visible as lipid peaks at 1210 nm, 1725 nm, and 1765 nm.
- Sensors configured to have 2.5 mm emitter-detector spacing were using to produce the plots of FIGS. 3 and 4 . It is estimated that the mean photon penetration depth is around 1 mm with the 2.5 mm spacing.
- fat accounts for about 20-30 percent of the total tissue traversed by near-infrared photons in piglets. It can be estimated that fat will account for a somewhat lower percentage in adult humans.
- FIG. 4 a plot of overhydrated porcine models superimposed on the plot of the euhydrated porcine model of FIG. 3 is illustrated.
- the lipid peaks are less prominent when the porcine models are in an overhydrated state.
- the relative amplitude of the lipid peaks is lessened because the skin thickness has increased as more water is stored in the skin in the overhydrated state.
- the thicker skin results in less of the near-infrared photons traversing the subcutaneous fat layer before being detected.
- removal of fluid from the piglets via ultrafiltration causes the fat peaks to become more prominent due to the skin becoming thinner and more of the photons reaching the subcutaneous fat layer.
- the thickness of the skin therefore, may be determined based on the amplitude of the fat spectrum relative to the other constituents, protein and water, present in the spectrum.
- the relative amplitude of the lipid features relative to the rest of the spectrum may be indicative of the water content of the skin.
- the relative amplitude may be determined by analysis of the full spectrum of a tissue site in comparison to the spectra of pure analytes (water, protein, and fat), as discussed in detail in U.S. Ser. No. 11/716,482 filed Mar. 9, 2007 and titled “Method and Apparatus for Spectroscopic Tissue Analyte Measurement,” which is incorporated herein by reference.
- the relative amplitude of the fat features may be determined using a relatively small number of selected wavelengths, one of which should be absorbed more strongly by fat than water. It has been determined that at least two wavelengths are needed for a reasonable determination of tissue water, so at least three wavelengths may be required to also incorporate an empirical determination of fat relative to water and protein.
- the relative amplitude of the lipid features in the NIR skin spectra is useful to determine skin thickness in humans.
- the skin thickness will vary between sites and between individuals, it may be assumed that the subcutaneous fat store is sufficiently thick at most sites to assure that NIR photons will not penetrate below it, and that virtually all the water and protein traversed by the NIR photons will be above the subcutaneous layer.
- a subcutaneous fat store of 10% of body weight would have a volume of 7800 cm 3 and, therefore, average about 4.3 mm thick.
- a correlation between the relative amplitude of the lipid features and skin thickness may be made.
- thinner skin may be indicated by a greater amplitude of the lipid features, including peaks, relative to the other constituents and thicker skin may be indicated by lesser relative amplitude of the lipid features.
- a correlation factor for correlation between the relative amplitude of lipid features and skin thickness may be empirically determined for specific sites. For example, site specific empirical testing may be performed comparing the relative amplitude of the fat features with water and protein to determine the correlation between the relative amplitude and the skin thickness.
- Skin thickness may be estimated using high frequency (near 15-20 MHz) ultrasound signals or Harpenden skinfold calipers.
- the skin thickness estimated by the ultrasound technique may be manually or automatically entered into the system 10 , while a skinfold estimate may be manually entered.
- the spectroscopic technique for determining skin thickness is based on the amount of light that penetrates to the subcutaneous fat layer and, in a transmission type sensor, all of the detected light passes through all the tissue layers a transmission type sensor is not adapted to make a skin thickness measurement. Accordingly, one of the above mentioned, techniques for determining skin thickness may be implemented when a transmission type sensor is used.
- FIG. 5 is a flow chart illustrating a technique 40 for analyzing these two factors to determine a water reserve index.
- the technique 40 includes estimating a lean water fraction value, as indicated at block 42 .
- the lean water fraction estimation may be performed spectroscopically by one of the above mentioned techniques.
- the system 10 of FIG. 1 may be configured to determine a lean water fraction in accordance with known algorithms.
- the technique 40 also includes estimating a skin thickness value, as indicated at block 44 .
- the skin thickness value may be performed in accordance with any one of the above mentioned methods, including spectroscopic, ultrasound, or caliper means. If, for example, the skin thickness is determined spectroscopically, the system 10 may be configured to determine both the lean water fraction value and the skin thickness value in addition to determining the water reserve index, as will be explained below. As described above, if the skin thickness measurement is made spectroscopically, at least three discrete wavelengths may be used, including one at which electromagnetic radiation is absorbed more by fat than by water.
- the computed water reserve index is indicative of the amount of water in the body and may be correlated to a clinically determined dehydrated condition.
- a water reserve index value may be empirically determined for a clinically dehydrated state.
- the computed water reserve index may use the clinically determined dehydrated water reserve index value as a baseline for determining the amount of water reserves above the dehydrated state.
- skin thickness and hydration values may vary based on the site at which the sensor 12 is taking measurements.
- the proposed hydration index may be site specific.
- Several means of indicating a skin site are known in the art and may include incorporating an electronic ID chip into sensor design for a specific site.
- One technique is disclosed in U.S. Ser. No. 11/716,264, filed Mar. 9, 2007 and titled “Method for Identification of Sensor Site by Local Skin Spectrum Data,” which is incorporated herein by reference.
- a particular sensor may be designed for use on a particular site, such as the forehead, for example, and it may contain an ID chip indicating that it is taking measurements from that particular site.
- the monitor 14 FIG.
- the monitor 14 may also have a keyboard 18 , or other input device, through which a user may communicate location detail to the monitor 14 .
- the monitor 14 may provide a display 20 that allows the user to indicate the sensor 12 location.
- the monitor 14 may calibrate itself accordingly to increase the accuracy of the system 10 .
- the monitor 14 may be configured to select appropriate coefficients or constants to be used in the algorithms to compensate for any location specific variation in skin thickness and/or hydration. Appropriate coefficients or constants associated with the determination of the lean water fraction, skin thickness, and/or water reserve index may be determined empirically based on clinical studies.
- the monitor 14 may be configured to allow a user, such as a clinician, to input baseline hydration levels for a particular site or, via the keyboard 18 . Specifically, for example, a user may enter the clinically determined dehydration values against which the computed water reserve index can be compared to determine if a patient is in a dehydrated or over hydrated state.
- the skin thickness measurement may, therefore, be adjusted for the elevation of the sensor site relative to the heart. Because the elevation dependent hydration changes occur primarily in the interstitial compartment, the elevation based adjustments may reflect the average elevation differences from the heart over the approximate equilibration time of the interstitial compartment, which may take tens of minutes.
- means of determining elevation changes relative to the heart might include settings on the surgical table or hospital bed, a camera, a small tube with fluid and a pressure sensor at one end.
- a water probe location sensor may include one or more mechanical linkages, such as, e.g., an arm with a joint, that attaches to a probe. In these cases, the position and/or orientation of a probe may be ascertained from the length of the arm, the angle of its joint, and/or the position of the subject.
- Remote water probe location sensors may also provide location information relative to the subject's body, such as, e.g., where a sensor uses optical and/or ultrasound emitters (e.g., on the probe, subject, and/or hospital bed) and detectors (e.g., on the sensor).
- a sensor may include a video camera and/or may use object recognition image processing software to detect probe location and/or tissue site position, orientation, and/or elevation.
- a sensor may also receive signals from one or more small piezoelectric vibratory gyroscopes located in a probe. These may be the same types of gyroscopes that may be used in automobile navigation systems and may allow detection of probe location information.
- Other alternative techniques may be implemented and the relative elevation of the sensor may be input to the monitor 14 via the keyboard 18 or the display 20 .
- the monitor 14 may be configured to use particular coefficients or constants to calibrate for site specific conditions as well as the elevation of the sensor site relative to the heart.
- the site specific information and the elevation information may be input manually via the keyboard 18 or monitor 20 .
- the sensor 12 and monitor 14 may be configured to automatically determine the elevation and site specific information.
Abstract
Description
Water Reserve=(Lean Water Fraction−offset)*Skin_Thickness,
where the offset takes into account that some of the water in the skin is tightly bound to proteins inside or outside of cells and cannot readily move around the body. The computed water reserve index is indicative of the amount of water in the body and may be correlated to a clinically determined dehydrated condition. Specifically, a water reserve index value may be empirically determined for a clinically dehydrated state. The computed water reserve index may use the clinically determined dehydrated water reserve index value as a baseline for determining the amount of water reserves above the dehydrated state.
Claims (9)
Priority Applications (3)
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US11/716,778 US8357090B2 (en) | 2007-03-09 | 2007-03-09 | Method and apparatus for estimating water reserves |
PCT/US2008/003013 WO2008112134A1 (en) | 2007-03-09 | 2008-03-06 | Method and apparatus for estimating water reserves |
US13/738,843 US20130123588A1 (en) | 2007-03-09 | 2013-01-10 | Method and Apparatus for Estimating Water Reserves |
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US11/716,778 US8357090B2 (en) | 2007-03-09 | 2007-03-09 | Method and apparatus for estimating water reserves |
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US8255025B2 (en) * | 2006-06-09 | 2012-08-28 | Nellcor Puritan Bennett Llc | Bronchial or tracheal tissular water content sensor and system |
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US20130123588A1 (en) | 2013-05-16 |
WO2008112134A1 (en) | 2008-09-18 |
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